Magnesium exposed babies have relaxed smooth muscle tone and are more likely to regurgitate and less likely to feed well.
Check the plumbing: any obstruction from mouth to anus can cause distension - the higher up, the quicker the symptoms.
Has the baby passed meconium?
Is this a premie?
NEC (necrotizing enterocolitis) is a very serious disease.
Management Approach -
If it appears to be just a little spitting up and especially if there is swallowed maternal blood in stomach: consider gastric lavage (there is a protocol in the nursery). If needed: NPO, IV D10w at 80% maintenance, careful observation.
If emesis is persistent or if distension is significant: NPO, IV 80-100 ml/kg/day, KUB, Orogastric tube to low intermittent suction. If Xray is normal and symptoms resolve, you may re-try feedings 12-24 hrs later. Screen for sepsis (CBCD, BC, consider CRP).
If you check and notice an imperforate anus or the x-ray looks like obstruction: NPO, IV @ 100ml/kg/day, Orogastric tube to low suction, screen for sepsis, if baby sick looking with poor perfusion: treat for sepsis. Will need transfer for Pediatric Surgical evaluation at CHO.
If NEC is suspected, always be proactive, call the peds attending!
Learning Objectives:
1) Assess a baby with feeding intolerance.
2) Discuss the differential of emesis, and know what red flags would cause you to refer to a higher level of care.
3) Describe the workup of a baby with no stool within 48 hours.
4) Describe how to initiate a work up of a baby with abdominal distention, emesis, or hematemesis.
Evaluation:
1) (yes/no) Resident has reviewed the above topics with an attending during the nursery rotation.
This page has been edited 8 times. The last modification was made by - cchou1 on May 10, 2011 3:09 pm
Important Concepts, Management Approach, and Materials -
Important Concepts -Management Approach -
Necrotizing Enterocolitis Powerpoint Presentation - Necrotizing Enterocolitis2010.ppt
Abdominal Wall Defects Powerpoint Presentation - Abdominal Wall Defects 2010.ppt
Learning Objectives:
1) Assess a baby with feeding intolerance.
2) Discuss the differential of emesis, and know what red flags would cause you to refer to a higher level of care.
3) Describe the workup of a baby with no stool within 48 hours.
4) Describe how to initiate a work up of a baby with abdominal distention, emesis, or hematemesis.
Evaluation:
1) (yes/no) Resident has reviewed the above topics with an attending during the nursery rotation.
This page has been edited 8 times. The last modification was made by -